FERTILITY TREATMENT: A personalised approach

FERTILITY TREATMENT: A personalised approach
22 Sep 2017

Fertility treatment has seen a great deal of progress over the last few years. As a result, a growing number of couples is actively exploring the different options available nowadays, commonly faced with questions, such as, “do I need such testing”, “will I benefit by having that treatment” and so on.

Reproductive medicine has enjoyed the results of excellent research in various fields of practice. However, not all breakthroughs may be beneficial to infertile couples. The aim of current practice in fertility investigation and treatment is selecting appropriate screening methods, while at the same time apply tailor made fertility treatments, based on specific data and individualized information for each couple. This approach, which is widely adopted in medicine as personalized medical practice, will provide the benefits of current progress in fertility treatment, while moving away from the “one-fits-all” concept.

In particular, we can now customize ovarian stimulation protocols in IVF, based on anti-Mullerian hormone (AMH), a marker of ovarian reserve in women, which is easily measured, and which helps to decide the type of protocol and the dose of medicine used. In this way, IVF protocols have now been adapted to individual needs, yielding higher pregnancy rates, while keeping rates of ovarian hyperstimulation syndrome very low.

Another example of personalized medicine in fertility treatment is the application of highly sophisticated time lapse technology, that allows closer monitoring of the embryos while in culture. Not all women need such close control, however, women of advanced age, with a history of unsuccessful IVF treatments, or with severe male factor infertility will benefit from the information provided. Pre-Implantation genetic screening is another relatively recent  technique available, that provides useful diagnostic information about the chromosomal structure of embryos. Again, while younger couples may not find the extra information provided useful, it is couples with advanced maternal age that will benefit from having an embryo transfer of a chromosomally normal embryo. In this way, miscarriages are less likely to happen and women will be spared the psychological burden of such a situation.

The endometrium is another area of intense research recently. Diagnostic tests and examinations may be applied in cases of repeated unexplained failed IVF cycles, usually in an outpatient setup. Hysteroscopy, along with a biopsy of endometrial tissue may provide useful information when there may be a question of polyps, fibroids, or issues of implantation, such as inflammation, or, even, a change in the window of implantation. Again, careful judgment of the prior history and fertility treatment will allow meaningful application of the available options.

If health professionals are to achieve the highest pregnancy rates, with the lowest intervention and cost, they will have to provide customized, personalized medical treatments to all interested couples seeking fertility treatment. In this way, not only will they improve the chance of pregnancy, but will truly take care of all individuals undergoing assisted reproduction treatments.

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Nikos Christoforidis

Reproductive Gynaecologist, MD, MRCOG, DFFP
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